HRMC announces $16.5 million expansion

Haywood Regional Medical Center is planning a $16.5 million expansion including a surgery support wing, an endoscopy unit, a new lobby and unfinished shell space for future expansion.

The expansion is being billed as a new surgery center, although it won’t actually include any new operating rooms. The hospital is keeping its current seven operating rooms and constructing a support wing adjacent to it. The wing will include a waiting room for family, storage for medical equipment, nursing stations and 20 hospital rooms where patients are prepped for surgery and spend their recovery.

Currently, surgery patients are shuttled around the hospital to different floors and wings during preparation for surgery and during recovery. Patients first visit the second floor for testing and screening, then the sixth floor where they await surgery. It’s back down to the first floor for their procedure and back up to the sixth for recovery. Meanwhile, the waiting area for families is on the second floor.

“It’s a very disjointed way of doing things,” said Dr. Alfred Mina, a surgeon who spoke at a community announcement for the addition two weeks ago.

Having the pre- and post-op rooms next door to surgery will give doctors better access to patients during recovery.

“If God forbid something was to happen, you will be right across the hall from the physicians that did the surgery,” Mina said.

Anesthesiologists who put patients under for surgery are equally excited about the project. They will be able to monitor patients better as they are waking up after surgery, said Dr. Jessica McCabe, an anesthesiologist.

“Overall, we believe this project will improve patient care,” said Eileen Lipham, a hospital vice president and project coordinator.

The face of surgery has changed significantly since the hospital was built in 1979. Then, patients almost always checked into the hospital for overnight stays when having surgery, so there wasn’t a need for a self-contained surgery wing. That’s not the case now.

“Over 70 percent of the surgery procedures we do are outpatient. They come in and leave the same day they have surgery,” Lipham said.

The surgery wing will have its own entrance and exit. The wing will be located to the left of the main entrance if facing the front of the hospital.

Currently, surgery volume at HRMC does not justify the need for additional operating rooms. In North Carolina, hospitals must get permission from the state for expansions or adding new services. Hospitals must justify the project by showing patient demand. Lipham said the hospital could not justify the need for extra rooms to the state.

“At this time we cannot demonstrate that need,” Lipham said. “In the next four to five years, if we continue to grow, we will go back and ask for more rooms.”

Another option?

David Rice, president of Haywood Regional Medical Center, said the project has been a cooperative process among hospital administration, nursing and doctors to arrive at the current plans.

“We have included every surgeon in the department and anesthesiology and anyone else who wanted to join in to help design the facility,” Rice said.

The expansion is not the first choice of some doctors, however.

“Certainly there has been a lot of discussion about whether there is a different way of doing things,” said Mina.

For example, the hospital could build a stand-alone surgery center, rather than one attached to the hospital. If the surgery center was a free-standing building, doctors would get a larger cut of revenue from the surgeries they perform.

As it stands, the hospital gets the lion’s share of revenue from medical services performed in its facility. Doctors bill for their procedures, while hospitals rake in the revenue for housing the patient, performing tests, running equipment, etc. By building a surgery center attached to the hospital, it perpetuates this model.

Another option would have been for the hospital to partner with doctors and surgeons in a joint venture. Under such a scenario, doctors share in the cost of construction but also own a stake in the facility and its operation.

Mina said the “vast majority” of physicians have agreed that a surgery wing constructed by and attached to the hospital is the best option at this point.

Dr. Bennie Sharpton, a long-time surgeon in the community, agreed.

“As a general rule of thumb, the medical staff is in support of this,” said Sharpton, also one of the invited speakers at the community meeting.

Sharpton said there has been discussion among doctors about the merits of a stand-alone surgery center. But Sharpton said the surgery volume in the community is not big enough yet for doctors to pull patients — and revenue — into a stand-alone facility and away from the hospital.

“It puts them frankly in competition with the hospital,” Sharpton said. “It is in our best interest to keep this institution strong and healthy and not too fractionalized now.”

In the future, as the community population grows, a stand-alone surgery center that gives doctors more autonomy could make sense, Sharpton said.

Rice also said there is not enough surgery volume to support a stand-alone surgery center. Rice said the surgery wing will be more efficient in terms of staffing.

Reading Room

Like some other readers I know, my taste in books these last 20 years or so has shifted from fiction to non-fiction, especially history, biography, and literary studies. I still follow certain novelists — Anne Tyler, Pat Conroy, James Lee Burke, and others — and still review novels for this paper, but find that works of fiction simply don’t appeal as much as when I was in my twenties and thirties, when I read stacks of novels and poetry.